UnitedHealthcare (UHC) denied our client’s long-term disability claim after cancer treatment, relying on a date in a form that didn’t reflect when she actually became unable to work. We clarified the true onset date with a treating-physician letter and a detailed oncology record—then resolved a “missing records” issue by resubmitting the file. Here’s what went wrong, how we fixed it, and what you can learn for your own LTD appeal.
The Roadblock: One APS Date ≠ Your True Disability Onset
UHC relied on an Attending Physician’s Statement (APS) listing a specific date as the “date advised to stop work,” but that date actually reflected the claimant’s first in-person visit with the physician—not the actual onset of disability. Therefore, the later date was simply the first date that the physician had an opportunity to advise the claimant to stop working. That is not the same as the actual first day of leave!
Our client’s disability began months earlier, supported by an earlier treating-physician letter.
What this teaches claimants: Insurers may give too much weight to a single answer on the Attending Physician Statement—especially if it can be used to deny your claim. Ensure your timeline is consistent across forms and records and supported by physician letters and appointment histories.
The “We Didn’t Get Your Records” Problem—And How We Solved It
Despite submitting over 1,700 pages of medical records and an affidavit. UHC still denied the claim, saying:
- The updated forms lacked specific diagnoses currently preventing work,
- The forms didn’t describe ongoing symptoms, and
- The medical records referenced in the forms weren’t received
These points were incorrect. The records and affidavit were clearly referenced and submitted together. No one flagged missing or unreadable files before the denial. We called UHC, the adjudicator agreed to reopen the claim, provided a dedicated fax number, and we resubmitted the entire packet. The claim was then approved.
Takeaway: “We didn’t receive it” is not the end of the road. Keep proof of what you sent, confirm the best way to submit information, and ask to reopen when a denial hinges on “missing” materials you already provided.
What You Can Do
- Map Your Timeline. Make sure the APS, questionnaires, and physician letters tell the same story. If you were functionally disabled before the “advised to stop work” date, add context in a doctor’s letter.
- Build a Transmission Record. Keep cover sheets, confirmation pages, and send logs. If the carrier claims they didn’t receive records, confirm the best way to submit documents (fax number/portal) and resend with proof.
- Request a Reopen When Warranted. If denial relied on “missing” documents that you submitted, ask the carrier to reopen the appeal and review the full file.
Quick FAQs
Does the APS date control my claim? No. The APS is one data point. Physician narrative letters and corroborating medical records can establish the true onset date.
What if the insurer says they never got my records? Resend through the carrier’s specified channel, include a clear index, and keep proof of your submission. If the denial relied on “missing” docs, request that they reopen your claim.
How Ortiz Law Firm Can Help
If your LTD claim was denied over a date discrepancy or “missing” records, we can review what happened and help you get the benefits you deserve. Call 888-321-8131 or contact us online for a free denial letter review. We represent claimants nationwide on ERISA-governed LTD appeals and lawsuits.
